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Rising rates of non-invasive ventilation and bronchopulmonary dysplasia: A propensity score-matched analysis

Journal of Perinatology volume 46, pages 224–232 (2026)Cite this article

Subjects

Abstract

Background

Given the multiple risk factors associated with bronchopulmonary dysplasia, the impact of advances in early respiratory management, particularly non-invasive ventilation, remains uncertain.

Methods

The early respiratory management and outcomes in 593 infants born at less than 32 weeks’ gestational age were retrospectively analyzed. The combined rate of bronchopulmonary dysplasia-mortality was compared across four propensity score-matched periods (2007-2010, 2011-2014, 2015-2018, 2019-2022).

Results

Delivery room intubation rate decreased from 54% to 36.7% (P < 0.001). Surfactant administration was delayed in the first three periods from 0.33 to 1.5 h (P < 0.001). The composite outcome of death or bronchopulmonary dysplasia rose from 14.9% to 39.8% over time, while mortality alone remained stable. In parallel, non-invasive ventilation duration increased with an adjusted mean difference of 21.98 days in 2019–2022.

Conclusion

The incidence of bronchopulmonary dysplasia continues to rise for very preterm infants, despite changes in early respiratory management and the increased use of non-invasive ventilation.

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Fig. 1: Evolution of early respiratory care practices for very preterm infants in the context of evolving recommendations between 2007 and 2022.
Fig. 2: Covariate balance after inverse probability of treatment weighting (IPTW) across multinomial treatment groups.

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Data availability

These data are generated from patient records as part of a retrospective study conducted in a Belgian academic hospital. The legal framework permits their consultation and use by investigators authorized by the ethics committee and hospital management. However, their reproduction or transmission is prohibited without institutional approval, as they are protected under GDPR.

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Funding

First author is the recipient of a Grant of The Belgian Kids’ Fund (BKF) for Pediatric Research. The other authors received no additional funding. Role of Funder/Sponsor (if any): The BKF had no role in the design or conduct of the study.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Hôpital Universitaire des Enfants Reine Fabiola, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium

    Emilie Goffinon & Aline Vuckovic

  2. Department of Obstetrics and Gynecology, University Hospital Brugmann, Université libre de Bruxelles, Brussels, Belgium

    Dominique A. Badr

  3. Department of Pulmonology, Allergology and Cystic Fibrosis, Hôpital Universitaire des Enfants Reine Fabiola, Hôpital Universitaire de Bruxelles, Université libre de Bruxelles, Brussels, Belgium

    Nicolas Lefèvre

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  4. Aline Vuckovic
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Contributions

Emilie Goffinon, MD, PhD student, made a substantial contribution to conception and design, to acquisition and interpretation of data, as well as to drafting of the article. Dr Goffinon provided final approval of the version to be published. Aline Vuckovic, MD, PhD, made a substantial contribution to conception and design, interpretation of data, as well as to drafting and revising the article critically for important intellectual content. Dr Vuckovic provided final approval of the version to be published. Dr Badr made a substantial contribution to the design of the study, data analysis, and data interpretation. He largely contributed to drafting the methodology/results section of the review manuscript and provided final approval of the submitted version. Nicolas Lefèvre, MD, PhD made a substantial contribution to revising the article critically for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Emilie Goffinon.

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Emilie Goffinon has no conflicts of interest to disclose. The other authors have no conflicts of interest to disclose.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. The local Ethics Committee approved the protocol (Nos. 21/19). No parental consent was needed due to the retrospective nature of this study. No identifiable images were used in this study.

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Goffinon, E., Badr, D.A., Lefèvre, N. et al. Rising rates of non-invasive ventilation and bronchopulmonary dysplasia: A propensity score-matched analysis. J Perinatol 46, 224–232 (2026). https://doi.org/10.1038/s41372-025-02494-9

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